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Section V
WHAT
ARE MICRONUTRIENTS
(Role
in Nutritional Support)
-
Compounds
are found in small quantities in all tissues, which are essential
for cell function.
-
Categorized
into vitamins and trace minerals or micro minerals.
-
Must
be consumed with nutrients as they cannot be made in man.
-
Deficiency
state will amplify any metabolic derangement.
Micronutrients
consists of the elements in the body found in very small quantities
which are essential for normal metabolic activity and processing of
nutrients for energy and for protein synthesis. The micronutrients
consist of the vitamins and micronutrients which in general are
not stored but continuously utilized and therefore require continued
enteral or parenteral replacement.
A micronutrient deficiency will not only produce metabolic dysfunction
but will markedly amplify any existing metabolic derangement such as
that seen after burn injury.
WHAT
ARE THE FUNCTIONS OF THE KEY VITAMINS AND MINERALS ?
These key vitamins and micro minerals have essential roles in
virtually all aspects of metabolic activity. The vitamins will be
discussed first. The water soluble vitamin B complex consists
of 12 vitamins, all which have key roles in nutrient processing to
energy production as well as protein synthesis. Vitamin B complex is
rapidly depleted and must be continually replaced.
Vitamin
C also
has multiple roles from wound healing to antioxidant activity. It is
also rapidly depleted and must be replaced daily.
Vitamin
A (fat soluble) is less rapidly
depleted but must be replaced because of its key roles in wound
healing and immune function.
Vitamin
E (fat soluble) is also less
rapidly depleted but must be replaced because of its key role as a
cell membrane antioxidant.
Vitamin
K is critical for clotting and is
usually not rapidly depleted but patient populations such as
alcoholics and clinically malnourished patients require early
replacement.
After burn injury vitamin requirements increase 5 to 10 fold due to
increased losses and increase utilization.
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Vitamin B Complex: required
for energy and protein synthesis
Vitamin C:
wound healing,
essential antioxidant
Vitamin
A: wound
healing, immune
function
Vitamin
E: essential
antioxidant
Vitamin
K: blood
clotting
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*
vitamin requirements increase 5-10 fold after burn injury
GLUTAMINE
ENRICHED MICRONUTRIENT DELIVERY SYSTEM TABLE
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Micronutrient
Support of the Hypermetabolic State
|
|
ENERGY
PRODUCTION
|
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VITAMIN
B
COMPLEX
|
|
DAILY
DOSE
|
|
.....Thiamine
|
Oxidation,
reduction reactions |
.....10–100
mg |
|
.....Riboflavin
|
Oxidative
phosphorylation for ATP production |
.....10
mg |
|
.....Niacin
|
Electron
transfer reactions for energy production |
.....150
mg |
|
.....Vitamin
B6
|
Transamination
for glucose production and breakdown |
.....10–15
mg |
|
.....Folate
|
One
carbon transfer reaction required for all macronutrient
metabolism |
.....0.4–1
mg |
|
.....Vitamin
B12
|
Coenzyme
A reactions for all nutrient use |
.....50
mcg |
|
.....VITAMIN
C
|
Carnitine
production for fatty acid metabolism |
.....500
mg–2 g |
|
.....MINERALS
|
|
|
|
.....Selenium
|
Cofactor
for fat metabolism |
.....100–150
mcg |
|
.....Copper
|
Cofactor
for cytochrome oxidase for energy production |
.....1–2
mg |
|
.....Zinc
|
Cofactor
for DNA, RNA, and polymerase for protein synthesis |
.....4–10
mcg |
|
.....AMINO
ACIDS
|
|
|
|
.....Glutamine
|
Nitrogen
shuttle for glucose amino acid breakdown,
urea production, direct source of cell energy |
.....10–20
g |
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|
|
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Micronutrient
Support for Wound Healing
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AMINO
ACIDS
|
|
DAILY
DOSE
|
|
Glutamine
|
Primary
fuel for fibroblasts
Preservation of lean mass
Anticatabolic, anabolic properties
Stimulates release of HGH |
see previous page |
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Arginine
|
Obligatory
precursor for wound protein synthesis
Increases local wound immune system |
|
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Cysteine
|
Key amino acid for new tissue growth
Provider of sulfhydryl bonds |
|
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VITAMINS
|
|
|
|
Vitamin
A
|
Stimulant for onset of wound-healing process
Stimulant of epithelialization and fibroblast
deposition of collagen |
|
|
Vitamin
C
|
Necessary
for collagen synthesis |
|
|
MINERALS
|
|
|
|
Zinc
|
Cofactor
for collagen and other wound protein synthesis |
|
|
Copper
|
Cofactor
for connective tissue production
Collagen cross-linking |
|
|
Manganese
|
Collagen
and ground substance synthesis
|
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GLUTAMINE
ENRICHED MICRONUTRIENT DELIVERY SYSTEM TABLE
(Water
soluble powder in individual packets)
| Micronutrient |
Amount |
%RDA |
| L-Glutamine |
10g |
+ |
| L-Arginine
(from zinc arginate) |
140
mg |
+ |
| N-acetyl-cysteine |
600
mg |
+ |
| Vitamin
A (from natural beta-carotene and mixed carotenoids) |
5,000
IU |
100% |
| Vitamin
E (as di-alpha-tocopheral) |
200
IU |
667% |
| Thiamin
(as thiamin HCL) |
6
mg |
400% |
| Riboflavin |
6.8
mg |
400% |
| Niacin
(as niacinmide) |
80
mg |
400% |
| Vitamin
B6 (as pyridoxine HCL) |
8
mg |
400% |
| Folate
(as folic acid) |
400
mcg |
100% |
| Vitamin
B12 (from dibencozide) |
50
mcg |
833% |
| Pantothenic
acid (as d-calcium pantothenate) |
40
mg |
400% |
| Magnesium
(as magnesium glycinate) |
200
mg |
50% |
| Zinc
(as zinc arginate) |
20
mg |
133% |
| Selenium
(as selenomethionine) |
100
mcg |
143% |
| Copper
(as copper lysinate) |
0.75
mg |
38% |
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*
Two to three packets each day, one every 8 to 12 hours will provide both
the necessary daily quantities and a constant flow of micronutrients
into the tissues for optimum utilization. (Cambridge
Nutraceuticals, Boston MA)
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